Healthcare Provider Details

I. General information

NPI: 1821097080
Provider Name (Legal Business Name): DAVID KHODADADIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/23/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357A CENTRAL AVE
BROOKLYN NY
11221-4701
US

IV. Provider business mailing address

357A CENTRAL AVE
BROOKLYN NY
11221-4701
US

V. Phone/Fax

Practice location:
  • Phone: 718-497-1757
  • Fax: 718-573-7856
Mailing address:
  • Phone: 917-853-4691
  • Fax: 718-573-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number202828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: